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Medicaid – Government Medical Program Essay

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Updated: Jan 22nd, 2020

Introduction

Medicaid is a US government program meant to uplift the standards of healthcare service provision for low income and poor families in America. It is probably one of the largest healthcare programs in the United States, at least on the basis of offering health services to low income and poor families (Blendon, 1993, p. 133). The program works by assessing the needs of the target population and determining their eligibility to enter the program.

Medicaid is usually run by state governments but its budget is overwhelmingly funded by the US federal government. The program is also unique to American citizens only, and it may stretch to dependants of eligible candidates, or people with disabilities, who fit within the admission criterion.

Medicaid has been in existence since 1965, through the provision of a social security act, meant to enable poor citizens in America get quality healthcare services (Gold, 2011, p. 1). Joining Medicaid is not a federal requirement because states have the option of declining or accepting the program.

Several states operate the program under different names; for example, California refers to the Medicaid program as “Medi-cal”, Massachusetts refers to the program as “Masshealth”, Tennessee refers to its program as “Tenncare”, and many other states use different names to represent the Medicaid scheme (Blendon, 1993, p. 133).

Some states also run the program alongside other health programs, such as the Child health insurance program, to improve the efficiency of healthcare services, while other states subcontract the program to private companies, which run the program or offer the program’s services to a state’s citizens, on its behalf. Since the Medicaid program is operated on a large scale, and every state has subscribed to it, it greatly affects the quality of healthcare services in America.

Indeed, the program touches a lot of American lives. Due to this reason, this study analyses the program in detail by studying the social problems. The program was initially intended to address; defining the target population of the program; characterizing the services provided in the program and defining its source of funding; defining the role of social workers in the program; evaluating the success of the program and suggesting possible policy changes which could be made to improve the program. These elements of study will be analyzed systematically.

Social Problem to be addressed

Medicaid was designed to address several social challenges in America. One of such challenge was the inability of low-income people in America to get good healthcare services because of their inability to pay for quality healthcare. Most of the people targeted for the program were American citizens (and their dependents) who lived in poverty (Gold, 2011, p. 1).

The program therefore helps this population group to partially or fully pay for healthcare. To a large degree, poverty was the greatest motivator to start the Medicaid program because America has in the past been dealing with the social burden of providing quality life (including healthcare) to people living in poverty.

If the current statistics are anything to go by, it is affirmed that, the current population of American citizens living in poverty is urgently in need of medical services because they cannot afford to subscribe to any meaningful healthcare insurance scheme (World Hunger Org, 2011). This is the reason why there was a need to change healthcare policies to address this social challenge.

As at 2009, poverty contributed to the increased statistics of Americans lacking any form of health insurance, and during the same period, it was estimated that, more than 40 million Americans did not have any sort of health insurance (World Hunger Org, 2011).

In 2007, it was estimated that, there were more than 16 million households categorized as low income; meaning that, this population group needed special attention with regards to healthcare needs. In the same year (2007), it was affirmed that, more than 15 million Americans lived in extreme poverty (meaning that, these families had an income of less than $10,000 a year, for a family of four children) (World Hunger Org, 2011).

In 2008, it was affirmed that more than 38 million Americans lived in poverty. This population group had special healthcare needs. From this analysis, we can therefore see that, poverty stood out as one social problem the Medicaid program was designed to address. This is the reason why low-asset eligibility is a requirement for admission into the program.

However, it should not be assumed that, poverty as an eligibility requirement, can effectively stand by itself. There are other eligibility categories which have to be fulfilled before consideration into the program. Apart from poverty, the Medicaid program was developed to address the social challenges people with disability in America faced, when trying to procure quality healthcare services.

The program was designed to be sensitive to the plight of disabled people because of the challenges they faced when trying to get gainful employment and their ability to make enough money to procure healthcare services. Disability is therefore a major social problem in America which Medicaid was designed to address because disabled people are subject to physical incapability while undertaking economic activities, and in the same regard, they are highly prone to discrimination when trying to seek available employment opportunities.

Moreover, disabled people are likely to require more healthcare services than non-disabled people. In this regard, they are highly unlikely to effectively pay for their healthcare needs.

Target Population

Since the Medicaid program was started, there has been an increase in the number of people covered under the scheme. There is a broad criterion used to determine the eligibility status of Medicaid beneficiaries but over the years, many people have been enrolled in the program because of their age. About a sixth of the population covered under the scheme has found its way into the program, based on the disability requirement (Gold, 2011, p. 2).

Flipping the statistics, it is estimated that, the healthcare program covers about one in every 10 Americans. The Medicaid program criterion for defining its population group easily follows the criterion described to characterize the social problems the program was meant to address.

These include poverty, disability and low-income family challenges (especially pregnant mothers and single parent families who cannot make enough money to sustain their basic needs). Initially, Medicaid was meant to cover a group of single parents living in welfare. However, adults under the low-income population group have been the biggest beneficiaries of the scheme because they are out of gainful employment, thereby increasing their susceptibility to extreme healthcare costs and diseases.

Currently, it has been affirmed that, more than 80% of Americans covered in the Medicaid program are adults above the age of 65 (Gold, 2011, p. 2). In this statistic, it is estimated that, the program covers about three million elderly persons. However, generally, the program was meant to target the uninsured population group in America, and especially people who could not afford to sustain their basic needs.

The presence of ill-health or disability is a crucial characteristic of the people targeted to benefit from the scheme because comprehensively, people with such characteristics exhibit the highest need for healthcare services. About four million persons with disability are estimated to be current beneficiaries of the program (Gold, 2011, p. 2).

The other major population group covered under the scheme is the children population group. The coverage of children and adults in the Medicaid program has in the past been compared to the coverage of the same population groups under private insurance, because the standards of healthcare have been confirmed to be almost the same for both schemes (Gold, 2011, p. 2).

Comprehensively, it is estimated that, low income adults and children covered in the program are equivalent to 20 million. This constitutes the largest group of people benefiting from the healthcare program. From the above understanding, we can therefore see that, the Medicaid program was meant to meet the need of low income children and adults; the elderly and the disabled people. These target groups are further encompassed under the category of Americans who cannot afford their own private insurance schemes.

Services and Funding

As mentioned earlier in this study, it is affirmed that, Medicaid services are normally offered by state hospitals, or are subcontracted to private institutions which provide the services on behalf of the state. There are several medical services covered by the Medicaid program including: ambulance services, audiology, dental services, dialysis, inpatient, outpatient and similar services (Gold, 2011, p. 3).

The kind of services to be provided under the Medicaid program is usually determined by the state and minimized to the bare minimum to ensure the required purpose for the service is achieved. There are normally several healthcare institutions which subscribe to the Medicaid program and such facilities are normally chosen by the eligible candidates for healthcare provision.

The choice regarding which facility to go to is therefore left to the patient. Patients can receive a variety of services under the Medicaid program and basic among them are: home service, institutional service and community service. Payments are however made by the state through several payment schemes such as the health maintenance organization.

Since the state is actively involved in running the Medicaid program, it also has a central role in funding the program. However, the Medicaid budget is normally co-funded by the state and the federal governments, which make it very different from the Medicare program, which is solely funded by the federal government (Graham, 2010, p. 918).

The percentage of federal funding is however not constant across all states because states normally have varying per capita income and due to this reason, the federal government waivers its funding guidelines, based on this criterion. However, the least federally funded state (states with the highest per capita income) normally receive a 50% federal funding rate (Gold, 2011, p. 2).

Over the years, state funding of the Medicaid program has been a contentious issue because most states spend between 16% and 22% of their total budget on the program. The number of people enrolled in the program also determines the total budget of the program because as at 2004, there were about 43 million Americans registered under the program and collectively, this had an impact of $295 billion to cover the entire population (Gold, 2011, p. 2).

In 2008, the total budget for the Medicaid program was estimated at about $204 billion. Payments accruing from the program also play a big role in the running of the program because it is estimated that about 60% of the payments made in the program go towards paying resident nurses and paying for close to 40% of the total childbirth services in America (Gold, 2011, p. 3).

The federal government usually pays for the rest of the budget, but a big percentage of the payment normally goes towards funding private health plans for retirees. The state also shoulders a part of this cost by paying a monthly fixed premium towards the same course. Through the health plan, beneficiaries of the scheme are able to enjoy several healthcare benefits, which would have otherwise been provided at a hospital.

Majority of the states (about 60%) provide their healthcare services in this manner (Gold, 2011, p. 3). Children and adults eligible for the program are normally enrolled in managed care programs but the aged are normally enrolled in conventional forms of healthcare (payment for services).

Recent legislative changes to the Medicaid program have expanded the scope of revenues that can be collected under the program, so that, instances of financial losses can be effectively reduced. States are estimated to benefit from these new policies by accruing a savings of about $1.1 billion, while the federal government is expected to save money to the tune of $1.4 billion (Gold, 2011, p. 3).

However, a greater percentage of the expenses accrued from the program is expected to be shouldered by recipients of the program. However, these legislative changes are likely to impact the number of people who can seek services under the scheme because it is feared that, only the sickest patients will seek services under the scheme while a majority of poor people will keep away to avoid paying the incremental costs.

Role of Social Workers

Social workers are a strong pillar in the working of the Medicaid program. One major function of the social worker is that they are the integrators or coordinators of the Medicaid program, in the sense that, their functions bring together various aspects of the Medicaid program to form a unified whole (Chechak, 2010).

The social workers bring about coordination in the program by acting as advocates for patients through the provision of technical assistance, either directly or indirectly, and by identifying coordination opportunities, which can be exploited by the administrators to further bring about more cohesion in the program.

Social workers also play an administrative role in the implementation of the Medicaid program, in the sense that, they are part of the administrative team which ensures all the resources availed for the program are used for the right purposes, and are used effectively. They carry out these functions with the aim of achieving the program goals, but periodically, they are also required to undertake assessment and monitoring programs to ensure the program operates on maximum efficiency.

This function ensures the sustainability of the program. Social workers also play the role of educators for all parties in the program because they have a lot of knowledge on how the program operates (Chechak, 2010). Often, they offer this service to patients seeking Medicaid services.

Moreover, considering social workers are empowered with excellent communication skills, they effectively bridge the gap between policy administrators and the target population. This analysis, gives the social workers a broker role, where their major task is to ensure the program administrators and the target population are in touch with one another.

Furthermore, through this role, social workers undertake the responsibility of ensuring the interest of the administrators and recipients are upheld throughout the program. Moreover, since social workers are empowered with the skill of evaluating how effective a program can be, they act as an invaluable asset to policy makers because they can recommend specific areas of improvement which can be applied to improve the effectiveness of the Medicaid program (Chechak, 2010).

Social workers also play the role of a facilitator in the Medicaid program, in the sense that; their responsibility is, “to expedite the change effort by bringing together people and lines of communication, channeling their activities and resources, and providing them with access to expertise” (Chechak, 2010, p. 4). In this regard, the social workers act as a medium to transfer information throughout the program and ensuring the recipients understand the importance or meaning of certain communications.

Finally, the social workers act as advocates for the recipients of the Medicaid program, in the sense that, they advance the grievances of the beneficiaries of the scheme and help the administrators understand the underlying problems facing the target population.

This gives a voice to the poor people targeted in the program because often, they do not have a framework which they can air their grievances to the administrators, because of their vulnerability in the society. For example, the disabled have a strong limitation of effectively airing their concerns to the program administrators because of physical constraints.

Program Evaluation

Since the start of the Medicaid program in 1965, Medicaid has largely been a success, considering it has provided healthcare to millions of people who would have otherwise lacked basic healthcare. In 1995, it is estimated that, more than 36 million Americans benefitted from the Medicaid program and of all the American healthcare schemes, Medicaid stands out as the only program that effectively provides healthcare services to people with diverse healthcare needs (Graham, 2010, p. 917).

Socially, the scheme has instilled confidence among America’s poor, of guaranteed healthcare services when they fall sick, and in this regard, it has improved the quality of life for America’s poor. More so, women, children, the disabled, and the elderly (who are the weakest in the population), have found a medical safety net for long-term treatment of healthcare needs.

Moreover, the low income groups have been able to enjoy preventive healthcare services, which elevate them to the same status as people enjoying employer-based healthcare services/insurance. America’s elderly, have also been able to receive long-term healthcare through the Medicaid program – a service they would have missed out if they pursued another alternative.

More so, the Medicaid program has been a success for the elderly population in America because a great majority of them depend on the program for their survival, especially considering the fact that, many have been faced with diseases which have wiped out their entire savings, leaving them very vulnerable. For many years, America has been grappling with the problem of understaffed institutions designed to take care of the elderly, but since the inception of the Medicaid program and its flexible nature, states have been able to improve the status of America’s elderly by putting them in community elderly homes (Graham, 2010, p. 917).

This move (courtesy of the Medicaid program) has been used to improve the quality of life for America’s elderly and indeed, provide a dignified life to the millions of America’s elderly who have given a lot to America, to position it where it is. The same story is noted of the move to provide a dignified life to America’s disabled (especially the mentally handicapped people).

Furthermore, the flexibility evidenced in the Medicaid program has also been instrumental in providing a framework for the contribution of the federal and state governments to work together towards improving the status of healthcare in America (Graham, 2010, p. 917). Moreover, the Medicaid program has stood out as a fertile ground for the improvement of healthcare services for the elderly.

The Medicaid program has not only effectively met the healthcare needs of America’s elderly and poor, it has also been used to effectively meet the needs of other segments of the population in the US. For instance, Graham (2010) notes that, “the Qualified Medicaid Beneficiary program, covers Medicaid premiums, deductibles, and co-payments for beneficiaries who have incomes below the federal poverty level” (p. 917).

It is estimated that, more than 16 million Americans, from poor households, take part in the program and it is from this basis that there has been a reduction in intensive care admissions, as opposed to outpatient care treatment.

Policy Changes

Though the Medicaid program has been a success in many respects, it does not mean that, the program lacks its fair share of faults. For example, the program is often marred by many challenges touching on its efficiency, and accountability (Graham, 2010, p. 917). It is for this reason that this study notes that, there should be more legislative and policy changes to be made to improve the level of accountability in the program and minimize the amount of wastages and fraud within the scheme.

To improve the level of accountability, strict policy measures should be introduced to increase the level of authorization of payments and purchases made in the program. More importantly, the stages of accountability should be increased to ensure a through check of the program’s finances is upheld at all times. Furthermore, increasing the severity of penalties for officers found embezzling the program’s funds should be done to deter officers who may want to take advantage of the poor for their own personal gain.

This will obviously minimize the level of fraud witnessed in the program. To improve the level of efficiency in the program, the minimum requirement for budget funding of the program should be increased to divert more state resources towards the implementation of the program.

In other words, there should be a policy change in the federal and state governments to divert a certain minimum percentage of funding (which should be raised) to the program. Already, there are excessive wastages in the government, such as the excessive military spending which could have otherwise been diverted to the healthcare sector.

Conclusion

This study notes that, the Medicaid program is a mainstream health program for the American people because it covers millions of Americans. The program’s target population is America’s poor, disabled and elderly population who cannot afford private insurance. In this regard, the program aims to tackle social challenges in America such as poverty, and the plight of the disabled.

The Medicaid program is therefore a sensitive health program for the American people, which should be approached with much sensitivity because it protects and guarantees quality healthcare for America’s most vulnerable population groups. As a result, more efforts and resources should be diverted towards making the program more efficient and reduce the wastages and fraud characterizing the program.

References

Blendon, R. (1993). Medicaid beneficiaries and health reform. Health Affairs, 12(1), 132-143.

Chechak, D. (2010). The Roles of a Social Worker. Retrieved

Gold, M. (2011). Medicaid’s Complex Goals: Challenges for Managed Care And Behavioral Health – Behavioral Health Care in Medicaid Managed Care Programmes. Web.

Graham, B. (2010). Medicaid Reform: Saving an American Success Story. Florida State University Law Review, 23, 917.

World Hunger Org. (2011). Facts. Web.

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